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Social Indicators Research

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26-09-2021 | Original Research

Public Health, Democracy, and Transition: Global Evidence and Post-Communism

Authors: Zafar Nazarov, Anastassia Obydenkova

Published in: Social Indicators Research | Issue 1/2022

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Abstract

Democracy is generally associated with governmental accountability, better public policy choices and public health. However, there is limited evidence about how political regime transition impacts public health. We use two samples of the states around the world to trace the impact of regime transition on public health: the first sample comprises 29 post-communist states, along with 20 consolidated democracies, for the period of 1970–2014; the second sample is a subsample of the same 29 post-communist states but only for the period of transition, 1990–2014. We find that the post-communist states experienced some decline in life expectancy in the first few years of transition (1990–1995). Yet, with a steady increase in the measure of democracy from 1995 onwards, life expectancy significantly improved and infant mortality decreased. Therefore, in the long run, democratization has had a positive impact on both the life expectancy and infant mortality of citizens of the post-communist states.

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The authors of this paper are listed alphabetically, and they contributed equally to this manuscript. Anastassia Obydenkova’s research was supported by the Basic Research Program of the National Research University Higher School of Economics (HSE University) and by the Fung Global Fund, Princeton Institute for International and Regional Studies, Princeton University (USA).

Several studies have demonstrated the direct link between public health and the measure of wellbeing, OECD Better Life Index (Durand, 2014; Mizobuchi, 2014; Balestraet al., 2018).

The major requirement to be part of this group is having a nearly perfect democracy in 1990 based on the Polity IV project’s Polity 2 index. The states that satisfy this requirement are mostly located either on the European or North American continents.

The subscript $i$ represents one of the 49 countries in the sample, and the subscript $t$ represents one of the 45 years from 1970 to 2014.

At the end of this timeframe, several countries, such as Hungary, Lithuania, Slovenia, the Czech Republic, Mongolia, Poland, and the Slovak Republic, had become newly established consolidated democracies, with the full set of democratic characteristics. Several countries, such as Turkmenistan, Bosnia, Uzbekistan, Kazakhstan, Azerbaijan, Tajikistan, Belarus, and Kyrgyzstan remained either completely undemocratic or with limited exposure to democratic institutions.

In Fig. 6, we depict the coefficients, $${\theta }_{1}-{\theta }_{6}$$, from the difference-in-difference regression (1). In this analysis, each period lasts five years. Thus, a single point in the figure represents the difference in the health outcome at a specific period, along with a 95% confidence interval surrounding this difference. The red line identifies the start of transition.

A 1% change in the independent variable leads to a 1% change in the dependent variable.

Indeed, states’ membership in international organizations such as multilateral development banks, for example, can be potentially a strong contributing factor to changes in international strategies of state-actors and at national level and so far it has received somewhat limited attention (e.g., Ben-Artzi 2016, Obydenkova and Rodrigues Vieira 2020). However, investigation of this issue and its implications for public health is beyond the scope of this paper at this stage but should stay on the agenda for further studies.

The later factors (misinformation and lack of trust to institutions and politicians) are especially relevant within the global health crisis and pandemic. Misinformation of the population potentially could have triggered counter-productive public behavior (e.g., radical decrease in basic safety measured required within the Pandemic).

Japan could be an interesting example, yet, admittedly, outside of the post-Communist region. Japan has one of the highest in the world life expectancy but also one of the highest level in quality of democracy and the welfare state. Potential studies could investigate this nexus at the global level beyond post-Communist Eastern European and Central Asian states, as this study did.

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Title: Public Health, Democracy, and Transition: Global Evidence and Post-Communism
Authors: Zafar Nazarov
Anastassia Obydenkova
Publication date: 26-09-2021
Publisher: Springer Netherlands
Published in: Social Indicators Research / Issue 1/2022
Print ISSN: 0303-8300
Electronic ISSN: 1573-0921
DOI: https://doi.org/10.1007/s11205-021-02770-z

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